CPT 64491 · Facet/MBB · Fidelis Care NJ (Centene) — NJ Medicaid
Facet/MBB — Cervical/Thoracic (2nd level) at Fidelis Care NJ (Centene) — NJ Medicaid.
How Fidelis Care NJ (Centene) — NJ Medicaid approaches CPT 64491 (Facet/MBB — Cervical/Thoracic (2nd level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
Evolent IPM 2025 + Fidelis NJ Medicaid Provider ManualCriteria summary
High-level themes from the Fidelis Care NJ (Centene) — NJ Medicaid policy of record for CPT 64491. Verbatim policy text and per-criterion analysis are available after sign-in.
- Conservative care expectations vary; sign in for specifics.
- Imaging concordance documentation required.
See the full Fidelis Care NJ (Centene) — NJ Medicaid criteria.
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